It is never normal – except if you’re pregnant or postmenopausal – for your period to stop or be irregular. Absence of the menstrual period for six months or more is called amenorrhoea, but there are two different kinds:

  • primary amenorrhoea – when menstruation does not start before 17 years of age; and
  • secondary amenorrhoea – where menstruation started but then stopped.

In this article we will focus on secondary amenorrhoea and what might have caused your period to come to a grinding halt. To find out why you may never have gotten a period, see our primary amenorrhoea article.

Reasons for a period pause
Pregnancy, lactation and menopause
Without stating the obvious, the most common reason why women stop having their periods is pregnancy, and the period while breastfeeding afterwards. You need to rule this out before you proceed to other diagnostic tests, and even if you don’t think it’s possible, if you’ve had a penis or semen anywhere near your vagina in the past couple of months, do a test anyway. This is a process of elimination. Home pregnancy tests are cheap and easy. Menopause means your periods will taper off and then stop altogether

Too much and/or too hard exercise
This can cause amenorrhoea by reducing the level of circulating oestrogens – that is, the oestrogen in your blood is excreted too quickly to have an impact on your tissues. Furthermore, if you are on a heavily restricted diet (calories and/or nutrients) while doing endurance exercises, you can disrupt the hypothalamic-pituitary-ovarian (HPO) axis resulting in hormonal – and period – disruptions.

A lot of vigorous exercise also increases your cortisol levels, a stress hormone, which interferes with your normal body function in lots of ways, including hormones.

Androgen excess
Androgens are masculinising hormones. Women have androgens too, but in smaller amounts than men, so if you have elevated androgen levels, this can cause your period to stop. If your amenorrhoea is caused by high levels of androgens, you may also experience other symptoms such as excessive hair growth on the face, oily skin, acne or loss of hair on the scalp.

Going off the pill
Rarer, but still possible, is hypothalamic or ‘post-pill’ amenorrhoea. If you have recently gone off the pill, wait it out for three months, and it should work itself out on its own.

Implanon, Depo Provera injection, hormonal IUDs or the ‘mini pill’ (progestogen-only)
Hormonal contraceptives can also stop your period due to the hormonal interactions, with these longer-acting hormonal contraceptives being famous for blocking periods for months at a time. In fact, that’s why some women like them.

Restricted or extreme dieting
When a woman’s body weight goes below the recommended body mass index (BMI) it may cause disruption to the body’s normal menstrual cycle and ovulation. When body fat goes below 25 per cent, amenorrhoea usually occurs – this is why fertility is traditionally related to voluptuous women and stick-insect models are not known for their fertility or sexuality. They are probably infertile at that time because they are so skinny.

This is also why skinny girls get their periods late.

Premature ovarian failure
This is a condition where ovary functions stop before the age of 40. The cause is unknown but it may arise from an autoimmune malfunction or can be triggered by chemo or radiotherapy. In ovarian failure, follicle stimulating hormone (FSH) and luteinising hormone (LH) are usually raised. An FSH level of ≥20 IU/l in someone under 40 would indicate an ovary problem.

PCO: polycystic ovaries
PCO (different from polycystic ovarian syndrome, PCOS) involves the presence of multiple immature ovarian follicles. Having PCO usually causes failure to ovulate and in turn infertility. It may or may not result in a loss of periods, depending on the state of the hormonal cascade that causes bleeding and ovulation. One in four women are found to have polycystic ovaries on ultrasound, and is considered normal, as it isn’t a disease or illness. It’s when it interferes with normal ovulation and causes infertility it is a problem.

PCOS: polycystic ovarian syndrome
PCOS is the most common reproductive-age condition affecting women, with nine per cent of women meeting the criteria for PCOS. PCOS involves the whole body, and has a hefty link to insulin resistance and blood-sugar dysregulation. Insulin resistance causes the pancreas to make more insulin, with the increased insulin levels affecting the ovary. This prevents ovulation and causes a rise in androgens (testosterone and friends). The rise in androgens causes the excess hair and acne commonly associated with PCOS.

Cushing’s syndrome, congenital adrenal hyperplasia or adrenal or ovarian cancer
These conditions all cause androgen excess and can stop periods in their tracks. Some cancers are androgen-producing which means they upset the natural balance of your cycles. CAH is with you from birth.

Cervical stenosis, Asherman’s syndrome or adhesions on the uterus
Uterine adhesions can be a cause of amenorrhea because they interfere with the ability of the uterus to build the endometrium, the lining that is shed (your ‘period’).

Thyroid conditions
Both an under and overactive thyroid can cause imbalances in androgen-oestrogen conversion. This can lead to ovulatory failure and therefore cessation of menstrual flow. Thyroid tests are notoriously unreliable, however low T4 with low thyroid-stimulating hormone (TSH) means your pituitary may be struggling. Low T4 causes the hypothalamus to release more thyrotropin- releasing hormone (TRH), which stimulates the release of prolactin – which stops your menstrual cycle for breastfeeding.

Pituitary problems
Pituitary gland damage because of tumour or surgical means can interfere with proper hormone regulation needed for the menstrual cycle to occur.

Hypothalamus problems
Low levels of hormone gonadotrophin suggest the hypothalamus is involved. The hypothalamus gets involved when you’re stressed or with excessive exercise/weight loss, which may be concomitant with an eating disorder. Serum gonadotropin levels may present as normal, however.

Drug or medications
Some antihypertensive and chemotherapy drugs can cause your period to stop, but so can heroin and other recreational drugs. Phenothiazines and metoclopramide raise prolactin levels (the hormone produced while breastfeeding) that causes the loss of periods.

Stress
Don’t underestimate the power of stress hormones to disrupt your business. Adrenaline and cortisol have an impact on all body systems, and can disrupt the HPO and HPA axis (hypothalamic-pituitary-ovarian and hypothalamic-pituitary-adrenal axis).

If you are anxious or stressed and your periods stop, you need to slow down and seek strategies to overcome or manage it. Your response to stress is an important part of being a beast, but life is weird and hard sometimes, and we freak out. Learn about it, manage it, and reduce the impact of stress hormones on your flesh and blood and brain.

Possible tests
What your doctor will do
Your doctor will do a routine check and history-taking. Be ready to give details and your own observations. A pregnancy test might be done if appropriate, as well as a BMI calculation.

Other diagnostics might be recommended if deemed necessary such as an investigation for follicle-stimulating hormone (FSH) and luteinising hormone (LH) and pelvic ultrasound. Your doctor will be looking for a physical reason why you aren’t having a period, like a blockage of some kind, cancers, growths, or hormonal imbalances that are easy to identify using blood tests.

What your naturopath will do
Charting your cycle will be a useful start, even though it seems like you aren’t having one – you are, but you just can’t see it. Your body is doing nothing except trying to ovulate and have a normal cycle, because this is your primary biological purpose in this life: to reproduce. Charting involves taking your temperature every morning before you do anything else (in bed), observing your vaginal fluids for changes, and writing it all down. There are spikes in hormones that can be observed using temperature (your temperature spikes ever-so-slightly just after you ovulate, and stays up until you bleed).

Stress is closely linked to hormonal disturbances, so your naturopath is going to discuss your emotional landscape with you to see what’s going on.

Nothing happens without a cause, so your naturopath will work with you to figure out what that might be, and correct it using whatever method is deemed appropriate: herbs, supplements, lifestyle and diet, plus whatever other therapies may help.

Treatments
Treatment of secondary amenorrhoea is naturally entirely dependent on the cause and vary widely between medical practitioners and naturopaths. All treatments can be effective, so you and your practitioner will determine the right one for you. Make sure you are informed before undertaking any treatments, and if necessary, get a second opinion. There is more than one way to skin a cat.

Some examples are thus:
If it is found out that your BMI is less than normal, a nutritional program may be recommended. If the cause is excessive exercise or stress-related, an appointment with a health counsellor or psychologist might be warranted.

For premature ovarian failure, hormone-replacement therapy may be suitable. For amenorrhoea caused by thyroid and pituitary problems, menstrual flow would most likely resume after treating the underlying thyroid or pituitary illness.

There are a lot of possible reasons why your period may have stopped, so it is important that you get help to find out why, and do it soon – if it turns out to be something bad, get it treated sooner rather than later.

Don’t underestimate the beauty of a good, solid regular period – it means a bunch of awesome things are working properly. 

 

References
Amenorrhoea; NICE CKS, June 2009
Maclaran K, Panay N, 2011, Premature ovarian failure. Journal of Family Planning and Reproductive Health Care. Jan;37(1):35-42
Barrack MT, Ackerman KE, Gibbs JC, 2013, Update on the female athlete triad. Curr Rev Musculoskelet Med. 2013 Apr 24
Dickerson EH, Raghunath AS, Atkin SL, 2009, Initial investigation of amenorrhoea, BMJ. 2009 Aug 4;339:b2184
Heiman DL, 2009, Amenorrhea. Primary Care. 2009 Mar;36(1):1-17, vii

 

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